E-Cigarette Use Among Youth and Young Adults

List of Abbreviations 253

List of Abbreviations

α4β2 alpha 4 beta 2-nicotinic acetylcholine 

receptor subtype

α7 alpha 7 nicotinic acetylcholine 

receptor subtype

α6 alpha 6 nicotinic acetylcholine 

receptor subtype

μg microgram

5AP tLTP protocol 5 action potential timing-dependent 

long-term potentiation protocol

5-CSRTT 5-choice serial reaction time task

5-HIAA 5-hydroxyindole acetic acid, the

primary metabolite of serotonin

5-HT1AR serotonin (5-hydroxytryptamine) 

receptor 1A

5-HT2A/C serotonin (5-hydroxytryptamine) 

receptor 2 A/C

86Rb+ efflux assay measure of nicotinic acetylcholine 

receptor function via rubidium-86 

ion efflux [125-I]a-Btx binding 

measurement of binding at a7 

nAChRs using the antagonist alphabungarotoxin

[125I]α-CtxMII binding measurement of binding at a6 

nAChRs using the antagonist alphaconotoxin MII

[125I]A-85380 binding measurement of binding at a4b2 

nAChRs using the agonist A-85380

A1 primary auditory cortex

AAP American Academy of Pediatrics

ACR American Association of Cancer 

Research

AARC American Association for Respiratory 

Care

ACP American College of Physicians

ACS American Cancer Society

ADHD attention deficit hyperactivity disorder

ADI acceptable daily intake

AEMSA American E-Liquid Manufacturing 

Standards Association 

AHA American Heart Association

AMPA a-amino-3-hydroxy-5-methyl-4-

isoxazolepropionic acid

AMPAR AMPA receptor

ANHCS Annenberg National Health

Communication Survey

ANR Americans for Nonsmokers’ Rights

AOR adjusted odds ratio

AP acetyl propionyl

APA American Psychiatric Association

APV advanced personal vaporizers

arc activity-regulated cytoskeletonassociated protein

ATF U.S. Department of Justice, Bureau 

of Alcohol, Tobacco, Firearms and 

Explosives

A-V atrial-ventricular

AVA American Vaping Association 

BART Balloon Analogue Risk Task

BCAP/CAP Committees of Advertising Practice 

(UK)

BLA basolateral amygdala

BNST bed nucleus of the stria terminalis

BOP Bureau of Prisons

BP blood pressure

CAD cinnamaldehyde

CAM cell-adhesion molecule

cAMP-PKA cyclic AMP-protein kinase A, signaling 

cascade

CARDIA Coronary Artery Risk Development in 

Young Adults

CASAA Consumer Advocates for Smoke-free 

Alternatives Association 

CCTA Contraband Cigarette Trafficking Act

CDC Centers for Disease Control and 

Prevention

CDER Center for Drug Evaluation and 

Research

C-DISC-IV Diagnostic Interview for Children−

Version 4

cFos protooncogene and immediate early 

gene used as a marker of neuronal 

activity

CFR Code of Federal Regulations

CI confidence interval

CMS Centers for Medicare & Medicaid 

Services

CO2 carbon dioxide

COMDTINST Commandant Instruction

CPP conditioned place preference

CPu caudate putamen

CREB cAMP response element-binding 

protein

CRF corticotropin-releasing factor
A Report of the Surgeon General

254 List of Abbreviations

CRP C-reactive protein

CSI Child Symptom Inventory

CTA conditioned taste aversion

CTP Center for Tobacco Products

D1R dopamine D1 receptor

DA diacetyl

DA dopamine

DAT1 dopamine regulation genotype

DEHP diethylhexyl phthalate

DEP diethyl phthalate

DHS U.S. Department of Homeland 

Security

DISC-YC Diagnostic Interview Schedule for 

Children-Parent Scale-Young Child

DoD U.S. Department of Defense

DOPAC 3,4-dihydroxyphenylacetic acid, 

metabolite of dopamine

DOT U.S. Department of Transportation

DSM-III Diagnostic and Statistical Manual of 

Mental Disorders, 3rd Edition

DSM-IV Diagnostic and Statistical Manual of 

Mental Disorders, 4th Edition

EC electronic cigarette

ECIG Inc. Electronic Cigarette Industry Group, 

Inc.

ECIG Ltd. Electronic Cigarettes International 

Group, Ltd.

ED U.S. Department of Education

ENDS electronic nicotine delivery systems

ENNDS electronic non-nicotine delivery 

systems

EOP Executive Office of the President

EPA U.S. Environmental Protection Agency

ERS European Respiratory Society

EPSC excitatory postsynaptic current

EPSDT Early and Periodic Screening, 

Diagnosis and Treatment

EPSP excitatory postsynaptic potential

ESD electronic smoking device

EU European Union

F1 first filial generation (and similar)

FAA Federal Aviation Administration

FCC Federal Communications Commission

FCLAA Federal Cigarette Labeling and 

Advertising Act

FCTC Framework Convention on Tobacco 

Control

FD&C Act Federal Food, Drug, and Cosmetic Act 

FDA U.S. Food and Drug Administration

FEF forced expiratory flow

FeNO exhaled nitric oxide 

FEV1 forced expiratory volume in 1 second 

fMRI functional magnetic resonance 

imaging

FR fixed ratio

FST forced swim test

FTC U.S. Federal Trade Commission

FVC forced vital capacity

FY fiscal year

G20 gestational day 20 (and similar)

g gram

GABA gamma-aminobutyric acid

GABAergic any cell, especially any neuron, that 

releases GABA

GPCR G-protein-coupled-receptor

GSA General Services Administration

GTP guanosine triphosphate

GTPase large family of hydrolase enzymes that 

can bind and hydrolyze GTP

HONC Hooked on Nicotine Checklist

HPLC-ECD high-performance liquid 

chromatography electrochemical 

detection

HUD U.S. Department of Housing and 

Urban Development

HVA homovanillic acid

IARC International Agency for Research on 

Cancer

ICD-10 International Statistical Classification 

of Diseases and Related Health 

Problems, 10th revision

ICE Bureau of Immigration and Customs 

Enforcement

ICR mice Institute for Cancer Research strain of 

mice

ICSS intracranial self-stimulation

IOM Institute of Medicine

i.p. intraperitoneal

IQ intelligence quotient

IRC Internal Revenue Code

i.v. intravenous

kg kilogram

KO knockout

L liter

L&M Liggett & Myers

LC-MS/MS liquid chromatography-tandem mass 

spectrometry
E-Cigarette Use Among Youth and Young Adults

List of Abbreviations 255

LH lateral hypothalamus

M&As mergers, formations of partnerships, 

and acquisitions

m2 square meter

m3 cubic meter

MAOA monoamine oxidase A

MAPK mitogen-activated protein kinase

MCH melanin-concentrating hormone

mFTQ modified Fagerström Tolerance 

Questionnaire

mg milligram

mGluR2 metabotropic glutamate receptor 2

mL milliliter

mPFC medial prefrontal cortex

mRNA messenger ribonucleic acid

MSN medium spiny neuron

MTF Monitoring the Future

NAB N-nitrosoanabasine

N2 nitrogen

NAc nucleus accumbens

NACDA National Advisory Council on Drug 

Abuse

nAChR nicotinic acetylcholine receptor

NAc-shell nucleus accumbens shell

NAT N-nitrosoanatabine

NATS National Adult Tobacco Survey

NCI National Cancer Institute

NDAA National Defense Authorization Act

NDSS Nicotine Dependence Syndrome Scale

NE norepinephrine

ng nanogram

NGFI-B nerve growth factor-induced gene-B

NHANES III Third National Health and Nutrition 

Examination Survey

NHSDA National Household Survey on Drug 

Abuse

NIH National Institutes of Health

NMDAR N-methyl-d-aspartate receptor

NIDA National Institute on Drug Abuse

NIOSH National Institute for Occupational 

Safety

NJYTS New Jersey Youth Tobacco Survey

NLSY National Longitudinal Survey of Youth

nm nanometer

NNN N-nitrosonornicotine

NNK 4-(methylnitrosamino)-1-(3-pyridyl)-

1-butanone

NRT nicotine replacement therapy

NYS New York State Follow-Up

NYTS National Youth Tobacco Survey

O2 oxygen

ODD oppositional defiant disorder

OMB Office of Management and Budget

OPM Office of Personnel Management

OR odds ratio

OSH Office on Smoking and Health

OSHA U.S. Department of Labor, 

Occupational Safety and Health 

Administration

P3 (and similar) postnatal day number

PACT Prevent All Cigarette Trafficking Act

PAH polycyclic aromatic hydrocarbon

PATH Population Assessment of Tobacco and 

Health

PDAY Pathological Determinants of 

Atherosclerosis in Youth

PFC prefrontal cortex

PHS Public Health Service

PIH Public and Indian Housing

PVN paraventricular nucleus of the 

thalamus

PG propylene glycol

PM particulate matter

PM2.5 fine particulate matter

PNE prenatal nicotine exposure

p.o. per os (by mouth)

Postn periostin, osteoblast-specific factor

PR progressive ratio

PREP potential reduced-exposure product

PVN paraventricular nucleus of the 

thalamus

qRT-PCR quantitative real-time polymerase 

chain reaction

RCRA Resource Conservation and Recovery 

Act

SAC saccharin

SAMHSA Substance Abuse and Mental Health 

Services Administration

s.c. subcutaneous

SCAN Screening test for Auditory Processing 

Disorders

SD standard deviation

SE standard error

sec seconds

SEC Securities and Exchange Commission

SES socioeconomic status
A Report of the Surgeon General

256 List of Abbreviations

SFATA Smoke Free Alternatives Trade 

Association

SIDS sudden infant death syndrome

SMC serial multiple choice

SNAP Special Supplemental Nutrition 

Program

SNP single-nucleotide polymorphism

SRITA Stanford Research into the Impact of 

Tobacco Advertising

STOP Smuggled Tobacco Prevention Act

TCR trigeminocardiac reflex

TEOAEs transient evoked otoacoustic 

emissions

TH tyrosine hydroxylase

THC tetrahydrocannabinol 

TSNA tobacco-specific nitrosamine

TTB U.S. Department of Treasury, Alcohol 

and Tobacco Tax and Trade Bureau

TVECA Tobacco Vapor Electronic Cigarette 

Association

UK United Kingdom

U.S.C. U.S. Code

USDA U.S. Department of Agriculture

USDHEW U.S. Department of Health, Education, 

and Welfare

USDHHS U.S. Department of Health and Human 

Services

USP U.S. Pharmacopeia

USTR U.S. Trade Representative

V voltage

VA U.S. Department of Veterans Affairs

VG vegetable glycerin

VOC volatile organic compound

VTA ventral tegmental area

WHO World Health Organization

WIC Women, Infants, and Children

Wnt Wingless-Type MMTV Integration 

Site Family, member 1, intracellular 

signaling factors

WT wild type

w/v weight/volume

YRBSS Youth Risk Behavior Surveillance 

System
E-Cigarette Use Among Youth and Young Adults

List of Tables and Figures 257

List of Tables and Figures1

1The Executive Summary and appendixes are not a part of the main report. Instead, they are available online at 

http:/www.surgeongeneral.gov/library/reports/.

Executive Summary

Figure 1 Trends in ever e-cigarette use among U.S. middle 

and high school students; National Youth 

Tobacco Survey (NYTS) 2011–2015 1

Figure 2 Trends in past-30-day e-cigarette use among 

U.S. middle and high school students; National 

Youth Tobacco Survey (NYTS) 2011–2015 2

Figure 3 Percentage of young adults who currently 

use e-cigarettes and conventional cigarettes; 

National Adult Tobacco Survey (NATS) 

2013–2014 2

Figure 4 Diversity of e-cigarette products 3

Figure 5 Percentage of middle school students, high 

school students, young adults (18–24 years of 

age), and adults (≥25 years of age) who currently 

use e-cigarettes 6

Figure 6 Percentage of middle school students, high 

school students, young adults (18–24 years of 

age), and adults (≥25 years of age) who have ever 

used e-cigarettes 7

Figure 7 Percentage of students in grades 8, 10, and 12 

who used e-cigarettes and cigarettes in the past 

30 days; Monitoring the Future (MTF) 2015 8

Chapter 1.

Introduction, Conclusions, and Historical Background 

Relative to E-Cigarettes

Table 1.1 Multinational tobacco companies with e-cigarette 

brands 15

Figure 1.1 Diversity of e-cigarette products 3

Figure 1.2 Parts of an e-cigarette device 12

Figure 1.3 Examples of e-liquid flavors 13

Figure 1.4 E-liquids being poured into an e-cigarette

device 13

Chapter 2.

Patterns of E-Cigarette Use Among U.S. Youth and 

Young Adults

Table 2.1a Percentage of middle school students who have 

used e-cigarettes, by gender and race/ethnicity; 

National Youth Tobacco Survey (NYTS) 

2015 29

Table 2.1b Percentage of high school students who have 

used e-cigarettes, by gender and race/ethnicity; 

National Youth Tobacco Survey (NYTS) 

2015 30

Table 2.2a Percentage of middle school students who used 

e-cigarettes in the past 30 days, by gender and

race/ethnicity; National Youth Tobacco Survey

(NYTS) 2011–2015 31

Table 2.2b Percentage of high school students who used 

e-cigarettes in the past 30 days, by gender and

race/ethnicity; National Youth Tobacco Survey

(NYTS) 2011–2015 32

Table 2.3a Percentage of middle school students who 

have ever used e-cigarettes, by gender and 

race/ethnicity; National Youth Tobacco Survey 

(NYTS) 2011–2015 34

Table 2.3b Percentage of high school students who have 

ever used e-cigarettes, by gender and race/

ethnicity; National Youth Tobacco Survey 

(NYTS) 2011–2015 35

Table 2.4a Percentage of young adults (18–24 years of age) 

who have used e-cigarettes, by gender, race/

ethnicity, and education; National Adult Tobacco 

Survey (NATS) 2013–2014 38

Table 2.4b Percentage of adults (≥25 years of age) who have 

used e-cigarettes, by gender, race/ethnicity, 

and education; National Adult Tobacco Survey 

(NATS) 2013–2014 39

Table 2.5 Percentage of students in grades 8, 10, and 12 who 

used e-cigarettes, cigarettes, or both products 

in the past 30 days, by sociodemographic 

characteristics; Monitoring the Future (MTF) 

2015 41

Table 2.6a Lifetime and past-30-day e-cigarette use among 

U.S. middle school students, by other tobacco 

product use; National Youth Tobacco Survey 

(NYTS) 2015 44

Table 2.6b Lifetime and past-30-day e-cigarette use among 

U.S. high school students, by other tobacco 

product use; National Youth Tobacco Survey 

(NYTS) 2015 45

Table 2.7a Percentage of middle school students who have 

ever used tobacco, by type of product; National 

Youth Tobacco Survey (NYTS) 2011–2015 47

Table 2.7b Percentage of high school students who have 

ever used tobacco, by type of product; National 

Youth Tobacco Survey (NYTS) 2011–2015 49
A Report of the Surgeon General

258 List of Tables and Figures

Table 2.8a Percentage of young adults (18–24 years of 

age) who currently use e-cigarettes, cigarettes, 

or both products, by gender, race/ethnicity, 

and education: National Adult Tobacco Survey 

(NATS) 2013–2014 54

Table 2.8b Percentage of adults (≥25 years of age) who 

currently use e-cigarettes, cigarettes, or 

both products, by gender, race/ethnicity, and 

education: National Adult Tobacco Survey 

(NATS) 2013–2014 55

Table 2.9 Percentage of youth (middle and high school 

students), young adults (18–24 years of age), 

and adults (≥25 years of age) using tobacco 

products who reported using flavored e-cigarette 

products, by gender and race/ethnicity; National 

Youth Tobacco Survey (NYTS) and National 

Adult Tobacco Survey (NATS) 60

Table 2.10 Summary of studies on e-cigarette flavors among 

youth and young adults 61

Table 2.11 Summary of studies on perceptions of e-cigarette 

harm among youth and young adults 65

Table 2.12a Percentage of middle school and high school 

students who reported that using e-cigarettes 

on some days but not every day caused no harm, 

little/some harm, or a lot of harm, by e-cigarette 

smoking status; National Youth Tobacco Survey 

(NYTS) 2015 73

Table 2.12b Percentage of middle school students who 

reported that using e-cigarettes on some days 

but not every day caused no harm, little/some 

harm, or a lot of harm, by e-cigarette smoking 

status; National Youth Tobacco Survey (NYTS) 

2015 73

Table 2.12c Percentage of high school students who 

reported that using e-cigarettes on some days 

but not every day caused no harm, little/some 

harm, or a lot of harm, by e-cigarette smoking 

status; National Youth Tobacco Survey (NYTS) 

2015 74

Table 2.12d Percentage of young adults (18–24 years of age) 

who reported that e-cigarettes were not at all 

harmful, moderately harmful, or very harmful, 

by e-cigarette smoking status; National Adult 

Tobacco Study (NATS) 2013–2014 74

Table 2.13 Summary of studies on reasons for use and 

discontinuation of e-cigarettes among youth 

and young adults 76

Figure 2.1 Trends in ever e-cigarette use among U.S. middle 

and high school students; National Youth 

Tobacco Survey (NYTS) 2011–2015 33

Figure 2.2 Trends in past-30-day e-cigarette use among 

U.S. middle and high school students; National 

Youth Tobacco Survey (NYTS) 2011–2015 36

Figure 2.3 Trends in ever e-cigarette use among U.S. adults 

by age group; Styles 2010–2014 40

Figure 2.4 Percentage of students in grades 8, 10, and 

12 who used e-cigarettes and cigarettes in the 

past 30 days; Monitoring the Future (MTF) 

2015 40

Figure 2.5 Past-30-day use of various tobacco products 

among U.S. middle and high school students; 

National Youth Tobacco Survey (NYTS) 

2015 46

Figure 2.6 Percentage of U.S. middle school students who 

have ever used tobacco, by type of product; 

National Youth Tobacco Survey (NYTS) 

2011–2015 51

Figure 2.7 Percentage of U.S. high school students who have 

ever used tobacco, by type of product; National 

Youth Tobacco Survey (NYTS) 2011–2015 52

Figure 2.8 Percentage of young adults who currently 

use e-cigarettes and conventional cigarettes; 

National Adult Tobacco Survey (NATS) 

2013–2014 53

Appendix 2.1.

Sources of Data

Table A2.1-1 Sources of national data on e-cigarette use 

among youth and young adults A2.1-4

Appendix 2.2.

Key Measures of Use

Table A2.2-1 E-cigarette items from sources of national data 

on e-cigarette use among youth and young 

adults A2.2-5

Table A2.2-2 E-cigarette items from PATH on e-cigarette use 

among youth and young adults A2.2-10

Appendix 2.3.

Other Supporting Literature

Table A2.3-1 Summary of studies on patterns of e-cigarette 

use among youth A.2.3-6

Table A2.3-2 Summary of studies on susceptibility and 

intentions to use e-cigarettes among youth and 

young adults 2.3-20

Table A2.3-3 Summary of studies on patterns of e-cigarette 

use among young adults 2.3-23

Chapter 3.

Health Effects of E-Cigarette Use Among U.S. Youth and 

Young Adults

Table 3.1 Relevant conclusions from previous Surgeon 

General’s reports on smoking and health 98
E-Cigarette Use Among Youth and Young Adults

List of Tables and Figures 259

Figure 3.1 Plasma nicotine concentration from different 

human laboratory studies and four different 

products with blood sampled before and 

immediately after a 10-puff bout with the 

products 103

Figure 3.2 Data showing exponential increase in the 

number of cases of human exposure to 

e-cigarette products and liquid nicotine between 

2011 and 2016 121

Figure 3.3 Changes in aerosol particle PM2.5 concentrations 

during experiment of e-cigarette use and 

tobacco cigarette smoking in an exposure 

chamber 123

Appendix 3.1.

Evidence Tables

Table A3.1-1 Studies on aerosolized nicotine and dependence, 

by dependency criteria A3.1-2

Table A3.1-2 Human studies on the effects of nicotine 

exposure on adolescent users A3.1-8

Table A3.1-3 Preclinical/animal studies on adolescent 

nicotine exposure A3.1-18

Table A3.1-4 Human studies on the effects of nicotine 

exposure on fetal brain development A3.1-33

Table A3.1-5 Preclinical/animal studies on fetal nicotine 

exposure A3.1-63

Chapter 4.

Activities of the E-Cigarette Companies

Table 4.1 Estimated e-cigarette market size in 2014 

($ billion) 150

Table 4.2 Estimated e-cigarette market size in 2015 

($ billion) 150

Table 4.3 Mergers, acquisitions, partnerships, and other 

agreements in the e-cigarette industry 165

Table 4.4 Comparison of website access restrictions, 

online sales, nicotine levels, and flavors 

among e-cigarette brands with no cigarette 

manufacturer affiliation, brands acquired by 

cigarette manufacturers, and brands developed 

by cigarette manufacturers 166

Figure 4.1 E-cigarette sales in tracked channels by brand, 

2010–2014 153

Figure 4.2 E-cigarette sales in tracked channels by product 

type, 2010–2014 154

Figure 4.3 Sales volume and price of disposable e-cigarettes, 

U.S. market, 2010–2014 155

Figure 4.4 Sales volume and price of rechargeable 

e-cigarettes, U.S. market, 2010–2014 156

Figure 4.5 Quarterly promotional spending for e-cigarettes, 

2010–2014 158

Figure 4.6 E-cigarette marketing claims 160

Appendix 4.1.

Major E-Cigarette Manufacturers

Table A4.1-1 Major e-cigarette manufacturers A4.1-2

Appendix 4.2.

E-Cigarette Trade Organizations and Advocacy Groups

Table A4.2-1 E-cigarette trade organizations and advocacy 

groups A4.2-2

Appendix 4.3.

The Rapidly Changing E-Cigarette Marketplace

Figure A4.3-1 Market share of e-cigarette products A4.3-3

Appendix 4.4.

Data Points for Figure 4.1

Table A4.4-1 Data points for Figure 4.1 (e-cigarette sales in 

tracked channels by brand, 2010–2014) A4.4-2

Appendix 4.5.

Evolution of Market Share in the E-Cigarette Market

Figure A4.5-1 E-cigarette market share in tracked channels by 

brand, 2010–2014 A4.5-3

Chapter 5.

E-Cigarette Policy and Practice Implications

Table 5.1 Comparative risk assessment: Potential harms 

and benefits of e-cigarettes 186

Table 5.2 Principle federal policies and regulations of 

tobacco that emphasize e-cigarettes 189

Table 5.3 Medical organizations 207

Figure 5.1 Potential patterns of use of combustible 

products (CPs) and e-cigarettes (e-cigs) 187

E-Cigarette Use Among Youth and Young Adults

Index 261

Index1

1Note: “t” following a number refers to a table; “f” following a number refers to a figure; “n” following a number refers to a note; and “A” 

preceding a number refers to an appendix.

1964 report. See Smoking and Health: Report of the Advisory 

Committee to the Surgeon General of the Public Health Service

(1964 report)

1988 report. See The Health Consequences of Smoking–Nicotine 

Addiction (1988 report)

1994 report. See Preventing Tobacco Use Among Young People

(1994 report)

2010 report. See How Tobacco Smoke Causes Disease–The 

Biologic and Behavioral Basis for Smoking-Attributable 

Disease (2010 report)

2012 report. See Preventing Tobacco Use Among Youth and 

Young Adults (2012 report)

2014 report. See The Health Consequences of Smoking—50 Years 

of Progress (2014 report)

A

AACR (American Association for Cancer Research), 206, 

208–209t

AAP (American Academy of Pediatrics), 206, 207t

AARC (American Association for Respiratory Care), 209t

Accord cigalikes, 9

Acetaldehyde, aerosolized adulterant, 117, 118

Acetone, aerosolized toxicant, 118

Acetyl propionyl, aerosolized flavorant, 116

Acrolein

aerosolized adulterant, 117, 118

e-cigarette component, 99

Addiction

aerosolized nicotine, 102–104, 103f

fetal effects of, A3.1-40 to A3.1-48t

long-term potential, 11, 239

smoking behavior changes, with low-nicotine cigarettes, 9

Surgeon General’s report (1988), 9, 97, 98t

withdrawal symptoms (physical abstinence syndrome), 102, 

A3.1-3 to A3.1-6t

ADHD. See Attention deficit hyperactivity disorder (ADHD)

Adolescents. See also Young adults; Youth

ages of, 4

brain development, 99

nicotine and brain development, 5

nicotine, increased sensitivity to, 105

pregnancy, 109

Adulterants, aerosolized, 100, 116–117

Adults (age ≥25). See also National Adult Tobacco Survey 

(NATS); Styles Survey

current prevalence of e-cigarette use, 37, 39t

flavors in e-cigarettes, 59, 60t

poly-tobacco use, 53, 55t

survey data sources, A2.1-2 to A2.1-3, A2.2-2

trends in prevalence of e-cigarette use, 37, 40f

Ad valorem excise tax, on tobacco products, 204

Advance cigarettes, 9

Advanced personal vaporizers, 150

Advertising. See also Marketing

behavior, effect on, 170–171

Broadcast Ban, 189t

burden of proof regarding safety, 238

cigarettes, 8–9

e-cigarette companies, 14–15

exposure to, youth and young adults, 169

protections for youth, 208t

receptivity to, youth and young adults, 169–170

restrictions, 238

Surgeon General’s report (2012), 4

targeting youth and young adults, 246–247

Advertorials, 205

Advocacy groups, e-cigarette industry, 15, A4.2-2 to A42-3t

USP-grade nicotine, 114

Aerosol inhalation

adulterants, 100, 116–117

aerosolized solvents, 115

cannabis and illicit drugs, 58

e-cigarette devices, 11

flavorants, 115–116

nicotine-related compounds, 114

non-nicotine constituents, 114–118

Aerosolized nicotine

cardiovascular function, 101

clean air policies, 188

dependence, 102–104, 103f, A3.1-2 to A3.1-7t

dose and effects of, 100–101, 103f

maternal exposure, and prenatal and postnatal health 

outcomes, 108–113

secondhand exposure, 120–123, 123f, 183, 209t, 240

thirdhand exposure, 209t

toxicants in, 208t, 219t, 229

youth, effects on, 104–107

Affordable Care Act (2010), 193t

African Americans. See Race/ethnicity

flavored little cigars and cigarillos, 11

retail sales of e-cigarettes, 150

Age-of-sale laws, 208t, 238, 241, 242, 244–245

Age, of starting tobacco use, 239, 241

Alameda County, California, public health department, 224

Alcohol and Tobacco Tax and Trade Bureau (TTB), 200t

Alcohol use

e-cigarette use, with, 57–58

maternal smoking, 111
A Report of the Surgeon General

262 Index

Allergic reactions, e-cigarette aerosol exposure, 123

Altered corpus callosum, fetal effects of nicotine exposure, 

A3.1-34t

Altria Group, Inc./Nu Mark. See also MarkTen e-cigarettes

acquisition, 165t

company profile, A4.1-2t

multinational tobacco company, 15t

Aluminum, aerosolized, 119

American Academy of Pediatrics (AAP), 206, 207t

American Association for Cancer Research (AACR), 206, 208–209t

American Association for Respiratory Care (AARC), 209t

American Association of Poison Control Centers, 14

American Cancer Society (ACS), 215t

American College of Physicians, 210t

American Heart Association, 216–217t

American Legacy Foundation (Truth Initiative), 158, 159, 163

American Lung Association, 218t, 224, 225

Americans for Nonsmokers’ Rights (ANR), 219t

American Society of Clinical Oncology, 206, 208–209t

American Thoracic Society, 211–212t

American Tobacco Company, 8

American Vaping Association (AVA), A4.2-2, A4.3-2

Amino-tadalafil, aerosolized adulterant, 117

Annenberg National Health Communication Survey, 171

ANR (Americans for Nonsmokers’ Rights), 219t

Antiandrogenic activity, DEP and DEHP, 117

Anxiety disorders

adolescent smoking, 107

Netherlands Study of Depression and Anxiety Disorders, 

A3.1-14t

Apnea, SIDS and maternal smoking, 109

Appetitive behaviors, fetal effects

appetitive behaviors, defined, 110

nicotine dependence, 110–111

other substances use, 111–112, A3.1-48 to A3.1-50t

overweight and obesity, 111, A3.1-51 to A3.1-53t

smoking uptake and nicotine dependence, A3.1-40 to 1-48t

Ariva smokeless tobacco product, 9

Arousal deficits, SIDS and maternal smoking, 109

Asthma

acrolein, 117

PG inhalation, 115

ATF (Bureau of Alcohol, Tobacco, Firearms and Explosives), 

198t

Atherogenesis, 101

Atherosclerosis, 118

Attention and cognition disorders, 106–107, A3.1-56 to 1-62t

Attention deficit hyperactivity disorder (ADHD)

comorbid substance abuse, 106

nicotine dependence, A3.1-13t

nicotine exposure, A3.1-11t

prenatal nicotine exposure, 112, 113, A3.1-14t, A3.1-49t,

A3.1-56 to A3.1-59t

Attitudes, knowledge, and risk perceptions, 171

Auditory processing, deficits in

e-cigarettes use, 7

fetal exposure to nicotine, 7, A3.1-35 to 1-39t

maternal cigarette smoking, 109–110

Autonomic function and SIDS, 109

AVA (American Vaping Association), A4.2-2, A4.3-2

Aversive stimuli, enhanced sensitivity to, 107, A3.1-27t

B

Ballantyne Brands (Mistic). See Mistic e-cigarettes

Batteries for e-cigarettes

explosions and fires, 14, 119

voltage and amount of carbonyl compounds, 117, 118

Bauway Technology Limited (Shenzhen, China), A4.1-14t

Behavior, advertising, effect of, 170–171

Behavioral disorders, A3.1-56 to A3.1-62t. See also Attention 

deficit hyperactivity disorder (ADHD)

Benzene, aerosolized, 118

Blacks. See Race/ethnicity

Blu (blu) e-cigarettes

advertising expenditures, 157, 159

e-liquid manufacture, 154

magazine advertisement, 160f, 161f

manufacturer of, 15t

marketing and promotion, 152, 153f

plasma nicotine concentration, 103f

sales (2010–2014), A4.4-2 to A4.4-6t

sponsorship of events, 159, 163

website access restrictions, 166t

BOP (Bureau of Prisons), 198t

Bradycardia, SIDS and maternal smoking, 109

Brain development and nicotine exposure

prenatal, 14, 99, 104–105, 109–110, 112–113

research needed, 185

studies on, A3.1-54 to A3.1-55t

youth and young adults, 104–106

Brand preference, development of, 157

British American Tobacco (BAT), 15t, A4.1-3t

Broadcast Ban, 189t

Bronchiolitis obliterans (popcorn lung disease), 116

Brown and Williamson (Advance cigarettes), 9

Burden of proof for product safety, 238, 242

Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), 198t

Bureau of Immigration and Customs Enforcement (ICE), 196t

Bureau of Prisons (BOP), 198t

Butanol, aerosolized, 118

Buttery flavor, aerosolized flavorant in e-liquids, 116

C

CAD (cinnamaldehyde)

aerosolized flavorant, 115

cytotoxicity of, 116

Cadmium, aerosolized, 119

California

Alameda County public health department, 224

Hayward tobacco products aimed at kids, case study, 224

licensing issues, 203

Camel cigarettes, 8

Cannabinoids/cannabis. See Marijuana

Car and Driver magazine, 162f
E-Cigarette Use Among Youth and Young Adults

Index 263

Carbonyls, aerosolized, 117, 118

Carcinogens

acrolein, 118

carbonyls, 117

DEHP, 117

NNN and NNK, 116

Cardiovascular function and disease, 101, 117, 118

Case studies

Hayward, California, tobacco products for kids, 224

North Dakota, clean indoor air, 225

CDC. See Centers for Disease Control and Prevention (CDC)

Center for Devices and Radiological Health (CDRH), 16

Center for Drug Evaluation and Research (CDER), 16

Center for Tobacco Policy and Organizing, 224

Center for Tobacco Products (CTP). See U.S. Food and Drug 

Administration (FDA)

Centers for Disease Control and Prevention (CDC)

aerosolized flavorants, 115

e-cigarette use among youth, A2.3-6t, A2.3-7t, A2.3-8t, A2.3-18t

flavors in e-cigarettes, 61t

patterns of e-cigarette use among youth adults, A2.3-27t

poison centers, increase in e-cigarette-related calls, 209t

statewide tobacco control programs, 238

surveys administered or sponsored by

National Adult Tobacco Survey, A2.1-3

National Youth Tobacco Survey, A2.1-2

Styles, A2.1-3

Centers for Medicare & Medicaid Services (CMS), 193–194t

ChangeLab Solutions, 224

Chemical exposure, e-cigarettes, 7, 208t

Chesterfield cigarettes, 8

Child Nicotine Poisoning Prevention Act (2015), 14, 120, 245

Child-resistant packaging for e-liquid containers, 14, 120, 208t, 245

China

e-cigarette companies and manufacturers, 14, 152, A4.1-12 to 

A4.1-14t

e-cigarette technology, 10

products imported from, 149

CHRNA5-A3-B4 haplotypes, gene cluster in nicotine addiction, 104

Chronic obstructive pulmonary disease, acrolein associated with, 117

Cigalikes, term usage, 3

Cigarettes 

early efforts to modify, 8

exclusive use of, compared to e-cigarettes, 6

filters and tar reduction, 8–9

price of, and use of e-cigarettes, 156

reduced-harm products, 8, 185

trafficking and smuggling, 198t

Cinnamaldehyde (CAD)

aerosolized flavorant, 115

cytotoxicity of, 116

Closed-system devices, 151

Cloud Pen e-cigarettes and devices, magazine advertisement, 161f

CMS (Centers for Medicare & Medicaid Services), 193–194t

Coalition on Smoking OR Health, 9

Cocaine use and prenatal nicotine exposure, 111

Cochrane database, NRT during pregnancy, 109

Cognition

adolescent smoking, 106–107

attention and cognition disorders, 106–107, A3.1-56 to 1-62t

deficits, with maternal smoking, 110

prenatal nicotine exposure, 112–113

Combustible tobacco products

decline in rates of using, 185

e-cigarette use associated with, 6

patterns of use, 187f

Comprehensive strategy approach, prevention, 238, 244

Conduct disorders, prenatal nicotine exposure, 112–113

Consumatory behaviors, maternal smoking, 110–111

Consumer perceptions

discontinuation, reasons for, 81t, 82t, 86, 87

e-cigarette use as normative, 15

perceived harm of e-cigarettes, 59, 64–71t, 87

PREPs, safety of, 10

use, reasons for, 75–86, 76–85t, 87

Contraband Cigarette Trafficking Act, reauthorized 2005 

(CCTA), 198t

Convenience stores, 167

Corpus callosum, alteration of

e-cigarettes, 7

fetal exposure to nicotine, 7

maternal smoking, 109

Cotinine salivary levels, secondhand smoke, 108

Cotinine serum levels

e-cigarettes, 99

new e-cigarette users, 102

secondhand smoke, 122

C-reactive protein (CRP), nicotine exposure, 101

Cross-sectional studies of poly-tobacco use

adults (age ≥25), 53, 55t

young adults, 53, 53f, 54t

youth

current prevalence, 37, 40f, 41–42t, 43, 44t, 45t, 46f

trends in prevalence, 43, 47–48t, 49–50t, 51f, 52f, 53

Crotonaldehyde, aerosolized toxicant, 118

CRP (C-reactive protein) nicotine exposure, 101

CTP (Center for Tobacco Products). See U.S. Food and Drug 

Administration (FDA)

Curiosity, as reason for trying e-cigarettes, 75, 87

D

Data for report, sources for, 27

Death, from ingestion of e-liquids, 14

Deeming rule

e-liquids, free samples of, 151

FDA authority over e-cigarettes, 6

free samples, 163

Internet sales to youth under age 18, 163, 164

minimum age requirements in retail environments, 167

modified risk claims, prohibiting, 163

source and provisions of, 17

vape shops, and mixing e-liquids, 169

DEHP (diethylhexyl phthalate), aerosolized adulterant, 117

DEP (diethyl phthalate) aerosolized adulterant, 117

Dependence on nicotine

aerosolized nicotine, 102–104, 103f, A3.1-2 to A3.1-7t
A Report of the Surgeon General

264 Index

maternal smoking, 110–111

Depression, adolescent smoking, 107

Dermatitis, e-cigarette aerosol exposure, 123

Diabetes type 2, fetal effects from nicotine exposure, 111

Diacetyl (2,3-butanedione), aerosolized flavorant, 116

Diethylhexyl phthalate (DEHP), aerosolized adulterant, 117

Diethyl phthalate (DEP) aerosolized adulterant, 117

Direct-drip atomizers, carbonyls, greater exposure to, 118

Disruptive disorders, adolescent smoking, 107

Distribution channels for e-cigarettes, 149–151

Dopamine system

abused drugs, 106

fetal effects from nicotine exposure, 112, 113

Dr. Scott’s Electric Cigarettes, 8

Drugs, illicit

aerosol inhalation, 58

e-cigarette products and devices, delivery system for, 6, 13–14

Dual use

advertising and, 170–171

defined, A2.2-3

health consequences, 186

policies discouraging practice of, 244

E

E-cigarette companies

activities of, 7

advertising and marketing, 14–15, 169–171

brands, categories of, 164–165

burden of proof regarding safety, 238, 242

China based, A4.1-12 to A4.1-14t, A4.3-2

consolidation of companies, A4.3-2

distribution and purchase channels, 149–150

e-cigarette market in the U.S., 149–154, 150t, 153f, 154f

e-liquids, production of, 154

FDA registration and disclosures, 242

independent private companies, A4.1-6 to A4.1-11t, A4.3-2

independent public companies, A4.1-4 to A4.1-6t, A4.3-2

marketing expenditures, 157–167, 158f, 160–162f, 165t, 166t

market share of products, 152

mergers, acquisitions, partnerships, and agreements, 165t

multinational companies, 15t

other product-related companies, A4.1-11 to A4.1-12t, A4.3-2

packaging, 242, 245

product evolution, 151–152

product standards, 242

retail outlets, 150t, 152–154, 153f, 154f, 167–169

sales projections, 14

sales volume and prices, 155–157, 155f, 156f

tobacco industry, A4.1-2 to A4.1-3t

visitors to websites, recruitment of, 14

websites, 165–166, 166f

E-cigarette policy and practice implications

agencies addressing specific populations, 243

case studies, 224–225

changing landscape, 184

clean indoor air, 188

comprehensive strategy relating to adverse consequences, 238

control measures, 184

educational initiatives, 206

future research, 185–186

health care practice, implications for, 203

licensing, 203

marketing restrictions, 205–206

overview, 7

pricing measures, 204–205, 238

public policy approaches, 187–188

risk tradeoffs, 184–185, 186t

taxation, 204–205, 238

tobacco-free spaces, 240

youth access and prevention, 203, 243–245

E-cigarette-related exposures, 14, 209t, 245

E-cigarettes

bridge to greater tobacco product use, 11

controversy over, 183

countries that have banned e-cigarettes/ENDS, 223t

discontinuation, reasons for, 81t, 82t, 86, 87

disposable, and prices, 3f, 152, 154, 154f, 155, 155f

federal regulation of, 15–18, 187–188

growth in awareness and use, 149

health effects

fetal brain development from nicotine exposure, A3.1-33 

to A3.1-62t

fetal nicotine exposure, preclinical/animal studies, A3.1-63 

to A3.1-79t

nicotine exposure effects, human studies, A3.1-8 to A3.1-17t

nicotine exposure effects, on fetal brain development, 

A3.1-33 to A3.1-62t

nicotine exposure effects, preclinical/animal studies, 

A3.1-18 to A3.1-32t

overview of, 6–7

historical background, 8–10

intentions to use summary data, A2.3-20 to A2.3-22t

invention of, 10–11

marketplace changes

market share of products, A4.3-3f, A4.5-2, A4.5-3 to A4.5-5f

tobacco industry, A4.1-2 to A4.1-3t

tracking of, 238

trade organizations and partnerships, A4.3-2

names used for, 5, A2.2-2

patterns of use, 6, 186, 187f, A2.3-6 to A2.3-19t, A2.3-23 to 

A2.3-37t

persistent use despite harmful consequences, A3.1-7t

physiological withdrawal state, A3.1-3t, A3.1-3 to A3.1-6t

potential harms and benefits, 185–186, 186t

preoccupation with, A3.1-7t

prevalence of use, 204, A2.3-2 to A2.3-3

price and sales volume, 7

products and devices

additional functions, 152

candy and menthol flavored, 211t

components of, 11, 12f

disposable, 3f

dose of inhaled nicotine, 100, 103f

evolution of, 151–152

illicit drugs, delivery system for, 6, 216t

modification of, 11
E-Cigarette Use Among Youth and Young Adults

Index 265

rechargeable, 3f

risks, 13–14

substances found in, 216t

types of, 3, 3f

public health concerns, 183

reasons for using, 6

rechargeable, and sales volume and price, 3f, 155–156, 156f

sales, tracked retail outlets, A4.4-2 to A4.4-6t

surveys

key measures, A2.2-2 to A2.2-4

methodologic information, A2.2-2

sources of data, A2.2-5 to A2.2-15t

susceptibility summary data, A2.3-20 to A2.3-22t

susceptibility to use, and advertising, 170

tolerance to effects, A3.1-6t

use, reasons for, 75–86, 76–85t, 87

use with other tobacco products (See Poly use)

without nicotine, health effects of, 17

E-cigars, appearance of, 3f

E-cigs (brand), 15

Eclipse cigalikes, 9

Educational attainment

adults (age ≥25), 39t

young adults, and e-cigarette use, 37, 38t

Educational initiatives

e-cigarette policies, 206

on ENDS products, 210t

health care professionals, 217t, 226, 241

media campaigns, 238

responsibility for, 239–241

United Nations organization on, 183

Educational plans of youth, 37, 41t

Electronic Cigarette Industry Group, Inc. (ECIG Inc.), A4.3-2

Electronic cigarettes. See entries beginning with E-cigarette

Electronic nicotine delivery systems (ENDS), 27. See also

E-cigarettes

Alcohol and Tobacco Tax and Trade Bureau, 200t

American Association for Cancer Research, 208–209t

American College of Physicians, 210t

Forum of International Respiratory Societies, 214t

International Union Against Tuberculosis and Lung Cancer, 223t

term usage, 27

World Health Organization, 219–220t

Elektro e-cigarettes, sales (2010–2014), 153f, A4.4-2 to A4.4-6t

E-liquids

adulterants, 100

child-resistant packaging, 14, 208t

concentration, and dose of inhaled nicotine, 100, 103f

devices, filling, 11, 13f

free samples, 151

ingestion of or exposure to, and health effects, 7, 119–120, 

121f, 184

nut allergy, and e-cigarette aerosol exposure, 123

production of, 154

refills, sales of, 154, 154f

taxation of, 204

vape shops, mixing in, 169

Employers, rewards or penalties for tobacco use, 194t

Ending the Tobacco Problem: A Blueprint for the Nation (IOM), 16

ENDS (electronic nicotine delivery systems), 27. See also

E-cigarettes

E-pipes, appearance of, 3f

Esquire magazine, 160f

Estrogenic activity, DEP and DEHP, 117

Ethnicity. See Race/ethnicity

European Commission, Tobacco Products Directive, 213t

European Medicines Agency, 117

European Respiratory Society (ERS), 213t

European Union (EU)

indoor air quality, 122

position on e-cigarettes and ENDS, 221t

Evaluation, policy impacts, 248

Ever (lifetime) use, defined, A2.2-2. See also High school 

students; Middle school students; National Youth Tobacco 

Survey (NYTS); Youth

EVIC tank device, 103f

Evod heating element, 103f

Exalt smokeless tobacco product, 9

Excise tax, on tobacco products, 204

Explosions caused by e-cigarette batteries, 14, 119

F

Facebook

advertising, 157

coupons and discounts, 163

distribution and purchase channels, 150

e-cigarettes, 15

Family Smoking Prevention and Tobacco Control Act of 2009, iii, 

9, 16, 18, 58, 183, 210t, 241

Favor cigarettes, 10

FDA. See U.S. Food and Drug Administration (FDA)

Fear responses, and adolescent smoking, 107

Federal Communications Commission (FCC), 189t

Federal Food, Drug, and Cosmetic Act, 16–17, 183, 241

Federal regulation of e-cigarettes. See also specific agencies by name

approach to, 15–18

policies of federal agencies, 189–202t

Tobacco Control Act, 187–188

Fetal effects of nicotine exposure. See also Pregnancy; Prenatal 

nicotine exposure

altered corpus callosum, 7, A3.1-34t

appetitive behaviors, A3.1-40 to 1-55t

attention and cognition, behavioral disorders, A3.1-56 to 

A3.1-62t

attention deficit hyperactivity disorder (ADHD), 112, 113, 

A3.1-14t, A3.1-49t, A3.1-56 to A3.1-59t

auditory processing defects, 7, A3.1-35 to 1-39t

brain development, 14, 99, 104–105, 109–110, 112–113

brain reward systems changes, A3.1-54 to A3.1-55t

cognition disorders, 112–113

conduct disorders, 112–113

obesity, 7

preclinical/animal studies, A3.1-63 to A3.1-79t

sudden infant death syndrome (SIDS), 7, 109, A3.1-33t

Filters, health, effects on, 8
A Report of the Surgeon General

266 Index

FIN e-cigarettes

magazine advertisement, 162f

television advertising, 159

website access restrictions, 166t

Fires caused by e-cigarette batteries, 14, 119

Flavors for e-cigarettes

addiction and use of conventional tobacco products, 11

aerosol inhalation, 115–116

flavors appealing to minors, California prohibiting, 151

Internet sales, 164

licensing requirements, 203

restrictions on, 242

safety of inhaling, 13, 184, 186

sales, growth of, 154

studies on, 58–59, 60t, 61–63t

sweet flavors, 11, 13f, 211t

youth and young adults, 6, 11

Food and Drug Administration (FDA). See U. S. Food and Drug 

Administration (FDA)

Food and Nutrition Act (2008), 190t

Formaldehyde

aerosolized adulterant, 117, 118

e-cigarettes, 99

higher temperature of e-cigarettes, 13

Forum of International Respiratory Societies, ENDS devices, 214t

4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), 

aerosolized adulterant, 116

Free samples; restrictions, 242

Frequent use, defined, A2.2-3. See also High school students; 

Middle school students; National Youth Tobacco Survey 

(NYTS); Youth

FTC. See U.S. Federal Trade Commission (FTC)

Future regulatory actions, 242

Future research initiatives, 185–186, 226

G

Gamucci e-cigarettes

company profile, A4.1-8t

market share (2010–2014), A4.5-3f

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

Gender differences

e-cigarette use

adults (age ≥25), 39t

high school, 28, 30t, 32t, 33, 35t, 37

middle school, 28, 29t, 31t, 33, 34t, 36

young adults, 37, 38t

flavors in e-cigarettes, 59, 60t

myelination gene expression with maternal smoking, 109

poly-tobacco use

adults (age ≥25), 55t

young adults, 53, 54t

youth, 37, 41t, 43

General Services Administration (GSA)

agency description, 190t

e-cigarette regulations, 188

smoking regulations, 190t

Genetics

gene expression alterations with maternal smoking, 109

genetically modified nontobacco plants, 17

genetically sensitive research designs, 112, 112n

nicotine addiction, 104

Glycidol, e-cigarette aerosol, 99

Glyoxal, aerosolized toxicant, 118

Green Smoke e-cigarettes

manufacturer, 15t

website information, 166, 166t

H

Halco, e-cigarettes, A4.1-8t

Halo Companies, Inc., A4.1-10t

Harm

reduced-harm products, 8, 185

reduction with e-cigarettes, and advertising, 171

strategies to prevent, 237–238

Haus e-cigarettes, sales (2010–2014), 153f, A4.4-2 to A4.4-6t

Health Belief Model, tobacco use, and perception of harm, 64

Health care practice, implications for, 203

Health care professionals, as education channel, 217t, 226, 241

The Health Consequences of Smoking—50 Years of Progress

(2014 report)

conceptual modeling, 186

conclusions from, 97, 99t

maternal cigarette use and disruptive-behavior disorders, 112, 113

passive use effects for pregnant women, 14

relevance of conclusions to e-cigarettes, 225

sensitivity of youth to nicotine effects, 99

The Health Consequences of Smoking–Nicotine Addiction (1988 

report)

conclusions from, 97, 98t

nicotine addiction, 9

Health effects

e-cigarette potential harms and benefits, 185–186, 186t

e-liquids, ingestion of, 7, 184, 245

nicotine and tar reduction, 8–9

risk tradeoffs and, 184–185

HealthStyles Survey, A2.1-3, A2.1-4 to A2.1-5t

Heat-not-burn products, 15t

Heavy metals, aerosolized, 119

High school students. See also Youth

current prevalence of e-cigarette use

ever use, 28, 30t

frequency of use, 28, 30t

past-30-day use, 28, 32t

susceptibility to use, 28, 30t

trends in prevalence of e-cigarette use

ever use, 33, 33f, 35t

past-30-day use, 32t, 36–37, 36f

Hill, Sir Austin Bradford, 186

Hippocampal function, adolescent smoking, 107

Hispanic population, retail sales of e-cigarettes, 150, 168

Hispanics. See Race/ethnicity

Hon Lik, 10

Hookah bars and lounges, 203
E-Cigarette Use Among Youth and Young Adults

Index 267

How Tobacco Smoke Causes Disease–The Biologic and 

Behavioral Basis for Smoking-Attributable Disease (2010 

report)

aerosols in e-cigarettes, 99

conclusions from, 97, 98t

Hypotension, SIDS and maternal smoking, 109

I

ICE (Bureau of Immigration and Customs Enforcement), 196t

Illicit uses. See also Marijuana

cocaine use and prenatal nicotine exposure, 111

European regulations, 213t

hashish oil, 14

methamphetamine, 111

Imperial Tobacco Group (Fontem Ventures)

acquisitions, 165t

advertising expenditures for blu, 157

company profile, A4.1-2t

Lorillard, 152

multinational tobacco company, 15t

Ruyan e-cigarettes, 10

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

Impulsivity in adulthood, adolescent smoking, 107

Indoor air policies, 122, 188, 225, 238, 243–244

Inflammatory mediators, nicotine exposure, 101

Ingredient disclosures, 17, 64, 215, 242

Instagram

advertising, 157

e-cigarette promotion, 166

e-cigarettes, 15

Institute of Medicine (IOM)

comprehensive tobacco control, 16

potentially reduced-exposure products, 9

Insurance coverage, rates for tobacco users, 194t. See also

Medicaid; Medicare

International cooperation

ENDS products, 209t

Tobacco Tax and Trade Bureau, 209t

International Union Against Tuberculosis and Lung Cancer, 223t

International Vapor Group (IVG), A4.1-7t

Internet

advertising, 157, 158f

age verification, 208t, 242

distribution and purchase channels, 150

e-cigarette companies, 14, 15

e-cigarette marketing, 10

e-cigarette promotion, 163

websites selling e-cigarettes, 163–164

IOM (Institute of Medicine)

comprehensive tobacco control, 16

potentially reduced-exposure products, 9

IQOS e-cigarettes, 15t

Iron, aerosolized, 119

J

Japan Tobacco International (JTI)

acquisition and partnership, 165t

company profile, A4.1-3t

multinational tobacco company, 15t

JieShiBo Technology (Shenzhen, China), A4.1-14t

Johnson Creek Vapor Company, 154, A4.1-11t

Joyetech Co., Ltd. (Shenzhen, China), 152, A4.1-12t

K

Kantar Media, 157, 159

Knowledge, attitudes, and risk perceptions, 171

Koop, C. Everett, 97

Korean Youth Risk Behavior Web-Based Survey (2011), A2.3-5

Krave e-cigarettes, sales (2010–2014), 153f, A4.4-2 to A4.4-6t

L

Labels

ingredients, 17, 64, 215

warning, 206, 211t, 213t, 216t, 240–241

Latinos. See Race/ethnicity

Lead, aerosolized, 119

Legislation to curb tobacco sales

Hayward, California, case study, 224

North Dakota, case study, 225

Licensing

e-cigarette policies, 203

retailers, 245

Lifetime (ever) use, defined, A2.2-2. See also High school 

students; Middle school students; National Youth Tobacco 

Survey (NYTS); Youth

Liggett & Myers (L&M), 8

Limbic system, long-term changes with nicotine exposure, 106

Literature search for report, 27

Litigation

FDA regulation of e-cigarettes, 187–188, 241

violations of existing local rules, 205

Local government, tobacco control, 16, 18. See also State, local, 

tribal, and territorial governments

Logic e-cigarettes

company profile, A4.1-8t

market share, (2012–2014), A4.5-4 to A4.5-5f

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

website information, 166, 166t

Longitudinal studies

data for report, source for, 27

poly-tobacco use, 53, 56–57

Lorillard (Lorillard Vapor Company)

acquisition, 165t

advertising expenditures for blu, 157, 159

blu, marketing of, 152, 153f

company profile, A4.1-3t

multinational tobacco company, 15t
A Report of the Surgeon General

268 Index

Lucky Strike cigarettes, 8

Lung cancer, and acrolein, 117

M

Machine testing of tar and nicotine yields, 8, 9

Magazines/print media, and advertising, 158–159, 158f, 160–162f

Mail-order sales, age verification, 208t

Manufacturers. See E-cigarette companies

Marijuana

aerosol inhalation, 58

e-cigarette devices used for, 6, 14, 58, 203, 241

e-cigarette use with, 57–58

open systems, 152

Ploom PAX e-cigarettes, 15t

poly-tobacco use, 57

tank devices, 14

“wax” marijuana resin, 14

Market for e-cigarettes in the U.S. See also Vape shops

distribution and purchase channels, 149–151, 154f

e-liquid production, 154

market share, evolution of, 152

product evolution, 151–152

sales in retail outlets, 150t, 152–154, 153f, 154f, 167–169

value of, 149, 150t

Marketing. See also Advertising

burden of proof regarding safety, 238

channels, 7

e-cigarette companies, 14–15

e-cigarettes, 7, 185

effect of advertising on behavior, 170–171

exposure and receptivity to advertising, 169–170

Internet, 10, 163

marketing expenditures, 157–167, 158f, 160–162f, 165t, 166t

restriction policies, 205–206, 208t, 238

retail environment, 167–169

self-service displays, 17, 203, 224, 242, 244

Surgeon General’s report (2012), 4

targeting youth and young adults, 246–247

themes, 7

MarkTen e-cigarettes. See also Altria Group, Inc./Nu Mark

distribution and purchase channels, 150

e-liquid manufacturers, 154

manufacturer, 15t

market share (2014), A4.5-5f

promotion of, 158

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

website information, 165, 166, 166t

Master Settlement Agreement (1998)

Hayward, California, case study, 224

marketing surveillance, 205

placement of e-cigarette advertisement, 168

point-of-sale advertising, 168

tobacco product sponsorship of events, 15, 159, 240

Maternal nicotine consumption. See Prenatal nicotine exposure

Maxim magazine, 160f

Medicaid

Incentives for Chronic Disease Prevention Program, 193t

prescription drug benefits, 193t

tobacco screening and cessation, 193–194t

Medical organizations

government health, 221–223t

professional organizations, 207–214t

voluntary health organizations, 215–219t

World Health Organization, 219–220t

Medicare, tobacco screening and cessation, 194t

Memory, adolescent smoking, 107. See also Cognition

Men’s Journal magazine, 160f

Metals, found in e-cigarettes, 216t

Methamphetamine use, fetal effects from nicotine exposure, 111

Methylglyoxal, aerosolized toxicant, 118

Middle school students. See also Youth

current prevalence of e-cigarette use

ever use, 28, 29t

frequency of use, 28, 29t

past-30-day use, 28, 31t

susceptibility to use, 28, 29t

trends in prevalence of e-cigarette use

ever use, 33, 33f, 34t

past-30-day use, 31t, 36, 36f

Minnesota Adult Tobacco Survey, A2.2-2

Mistic e-cigarettes

company profile, A4.1-6t

magazine advertisement, 161f

market share, (2012), A4.5-4f

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

website access restrictions, 166t

“Mods.” See Tank devices (“mods”)

Monitoring the Future Survey (MTF)

data for report, source for, 27

e-cigarette use

items from sources of national data, A2.2-5 to A2.2-9t

sources of national data, A2.1-4 to A2.1-5t

e-cigarette use, current prevalence, 28

flavors in e-cigarettes, 59

poly-tobacco use, 37, 40f, 41–42t

profile of, A2.1-2

Monoamine oxidase A, fetal effects from nicotine exposure, 113

Mood disorders, adolescent smoking, 107. See also Anxiety disorders

Moratoriums, on vape shops, 203

MTF. See Monitoring the Future Survey (MTF)

Myelination

gene expression alterations with maternal smoking, 109

nicotine exposure, 104–105

N

NAB (N-nitrosoanabasine), aerosolized adulterant, 116

NACDA (National Advisory Council on Drug Abuse), 195t

NAChRs. See Nicotinic acetylcholine receptors (nAChRs)

NAT (N-nitrosoanatabine), aerosolized adulterant, 116

National Adult Tobacco Survey (NATS)

comparison to 2013–2014 survey, A2.3-3

data for report, source for, 27, A2.1-3, A2.1-4 to A2.1-5t

e-cigarette use data, A2.2-5 to A2.2-9t

flavors in e-cigarettes, 59, 60t
E-Cigarette Use Among Youth and Young Adults

Index 269

poly-tobacco use, 53, 53f, 54t, 55t

prevalence of e-cigarette use, 37, 38t, 39t

young adults

e-cigarette use, A2.3-3

perceived harm of e-cigarettes, 64, 74t, 75

National Center for Health Statistics, 27

National Comorbidity Survey—Adolescent dataset, 102

National Defense Authorization Act (2015), 191t

National Health Interview Survey (NHIS), A2.1-4 to A2.1-5t, A2.3-3

National Institute for Occupational Safety (NIOSH), 116

National Institute on Drug Abuse (NIDA)

Monitoring the Future Survey, A2.1-2

Population Assessment of Tobacco and Health Study, A2.1-3

tobacco industry-supported research and funding, 195t

National Institutes of Health (NIH)

supporting e-cigarette research, 186

tobacco-free initiative, 195t

National Library of Medicine, 27

National Park Service

e-cigarette regulations, 188

role in implementing strategies, 243

National Tobacco Company, 165t

National Youth Tobacco Survey (NYTS)

advertising

effect on behavior, 170

exposure to e-cigarette, 169

current e-cigarette use by youth, increase of, 10

current prevalence of e-cigarette use

ever use, 28, 29t, 30t

frequency of use, 28, 29t, 30t

past-30-day use, 28, 31t, 32t

susceptibility to use, 28, 29t, 30t

data for report, source for, 27

e-cigarette use data

items from sources of national data, A2.2-5 to A2.2-9t

measures used, A2.2-4

patterns of use, 2015 survey, A2.3-2

sources of national data, A2.1-4 to A2.1-5t

survey description, A2.1-2

flavors in e-cigarettes, 59, 60t

perceived harm of e-cigarettes, 64, 73t, 74t

poly-tobacco use

current prevalence, 43, 44t, 45t, 46f

trends in prevalence, 43, 47–48t, 49–50t, 51f, 52f, 53

survey profile, A2.1-2

trends in prevalence of e-cigarette use

ever use, 28, 33, 33f, 34t, 35t

past-30-day use, 31t, 32t, 36–37, 36f

NATS. See National Adult Tobacco Survey (NATS)

Netherlands Study of Depression and Anxiety Disorders, A3.1-14t

Netherlands Twin Registry, 106

Neurobehavioral disorders of childhood, A3.1-56 to A3.1-62t

Neurobiological development, 104–106

Neuroteratogens, 14

New Jersey Youth Tobacco Survey (NJYTS), 33, A2.2-4

NHALE, Inc., A4.1-6t

Nickel, aerosolized, 119

Nicolites e-cigarettes, 15t

Nicorette inhalators, 116

Nicotek e-cigarettes

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

website access restrictions, 166t

Nicotek LLC, A4.1-9t

Nicotine

addiction and fetal effects, A3.1-40 to A3.1-48t

adverse effects during pregnancy, 208t

Camel cigarettes, and high nicotine content, 8

genetically modified nontobacco plants, 17

higher temperature of e-cigarettes, 13

poisoning, with ingestion of e-liquids, 119–120, 121f

reduction of content, health effects of, 8–9

role of, and nicotine delivery, 9

secondhand exposure, and California level standards, 123

Nicotine-related compounds, aerosol inhalation of, 114

Nicotine replacement therapy (NRT)

cardiovascular risk, 101

Nicorette inhalators, 116

pregnancy, 108–109

Nicotinic acetylcholine receptors (nAChRs)

adolescence, 105

e-cigarette addiction, 102

fetal development, 108, 110

NicSelect, A4.1-11t

NIDA. See National Institute on Drug Abuse (NIDA)

NIH. See National Institutes of Health (NIH)

NIOSH (National Institute for Occupational Safety), 116

Nitric oxide, aerosol inhalation, 114

NJOY cigalikes

company profile, A4.1-7t

e-liquid manufacture, 154

funding for study on flavors in e-cigarettes, 59

magazine advertisement, 161f

market share (2010–2014), A4.5-2 to A4.5-5f

product evolution, 151

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

television advertising, 159

website access restrictions, 166t

N-nitrosoanabasine (NAB), aerosolized adulterant, 116

N-nitrosoanatabine (NAT), aerosolized adulterant, 116

N-nitrosonornicotine (NNN), 116

NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone), 116

NNN (N-nitrosonornicotine), 116

Nonusers. See Environmental exposure

North America Tobacco Regulatory Laboratory Network, 200t

North Dakota Center for Tobacco Prevention and Control Policy, 225

NRT (nicotine replacement therapy)

cardiovascular risk, 101

Nicorette inhalators, 116

pregnancy, 108–109

NuMark. See Altria Group, Inc./Nu Mark

Nut allergy, and e-cigarette aerosol exposure, 123

NYTS. See National Youth Tobacco Survey (NYTS)

O

Obesity. See Overweight and obesity

Occupational Safety and Health Administration (OSHA), 199t
A Report of the Surgeon General

270 Index

Ocular irritation, acrolein, 117

Office of Management and Budget (OMB), 189t

Office of Personnel Management (OPM), 190t

Old Gold cigarettes, 8

OMB (Office of Management and Budget), 189t

Omni cigarettes, 9

Open system devices, 151–152

OPM (Office of Personnel Management), 190t

Oppositional defiant disorder (ODD), 107

OSHA (Occupational Safety and Health Administration), 199t

Overweight and obesity

e-cigarettes, 7

fetal effects from nicotine exposure, 7, 111, A3.1-51 to A3.1-53t

P

Particulate matter 2.5 (PM2.5), secondhand smoke measure, 122, 123f

Past-30-day use, defined, A2.2-2. See also High school students; 

Middle school students; National Youth Tobacco Survey 

(NYTS); Youth

PATH study. See Population Assessment of Tobacco and Health 

(PATH) study

Patient Protection and Affordable Care Act of 2010 (PPACA), 193t

PG. See Propylene glycol (PG)

Philip Morris International (PMI), 15t, A4.1-2t

Physical abstinence syndrome (withdrawal symptoms), 102, 

A3.1-3 to A3.1-6t

Physiological withdrawal state, electronic cigarettes, A3.1-3t

Pipeline and Hazardous Materials Safety Administration, 199t

Plasma nicotine concentration, 103f

Plasticity of the brain, 104–105, 113

Ploom e-cigarettes, 15t

Ploom vaporizers, 15t, 165t

PM2.5 (particulate matter 2.5), secondhand smoke measure, 122, 123f

PMI (Philip Morris International), 15t, A4.1-2t

Poison control centers, e-cigarette-related exposures, 14, 209t, 245

Poly use

adults, cross-sectional studies, 53, 55t

defined, A2.2-3

educational plans of youth, 37, 41t

gender differences

adults (age ≥25), 55t

young adults, 53, 54t

youth, 37, 41t, 43

longitudinal studies, 56–57

marijuana, 57

race/ethnicity

adults (age ≥25), 55t

young adults, 53, 54t

youth, 37, 41t

young adults, cross-sectional studies, 53, 53f, 54t

youth

current prevalence, 37, 40f, 41–42t, 43, 44t, 45t, 46f

educational plans of, 37, 41t

trends in prevalence, 43, 47–48t, 49–50t, 51f, 52f, 53

Popcorn lung disease (bronchiolitis obliterans), 116

Population Assessment of Tobacco and Health (PATH) Study

e-cigarette use

items from sources of national data, A2.2-2 to A2.2-15t

patterns of use, 2013–2014 study, A2.3-2

sources of national data, A2.1-4 to A2.1-5t

flavors in e-cigarettes, 59

overview, A2.1-2

profile of, A2.1-3

Population-level strategies, 243

Porter Novelli (public relations firm), A2.1-3

Potentially reduced-exposure products (PREPs), 9–10

Precautionary approach strategy, 238

Precautionary principle

appropriate use of, 183

as guide for decision makers, 188

as guide to address e-cigarette use, 4

Prefrontal cortex, development of, in adolescents and young 

adults, 105

Pregnancy. See also Fetal effects of nicotine exposure; Prenatal 

nicotine exposure

adverse effects of nicotine, 7, 208t, 239

e-cigarettes as tobacco cessation option, 206

nicotine exposure, 14

nicotine use, 5, 7, 14

tobacco screening cessation services, 193–194t

Premarket reviews, 242

Premier, smokeless cigarette product, 9

Prenatal nicotine exposure. See also Fetal effects of nicotine 

exposure; Pregnancy

appetitive and consumatory behaviors, 110–112

attention and cognition, 112–113

auditory processing deficits, 109–110

cocaine use, 111

corpus callosum, altered development of, 109

discordant sibling pair design studies, 111

e-cigarettes, 14

nicotine, 5, 7

nicotine concentrations in fetal fluid, 108

prenatal and postnatal outcomes, 108–113

sudden infant death syndrome (SIDS), 109

toxicants and, 108, 109

PREPs (potentially reduced-exposure products), 9–10

Prevent All Cigarette Trafficking Act (2009), 164

Preventing Tobacco Use Among Young People (1994 report), 4

Preventing Tobacco Use Among Youth and Young Adults (2012 

report)

conclusions from, 97, 98t

educational initiatives, 206

marketing influence in tobacco use behaviors, 157

release of, 4

sensitivity of youth to, 99

Pricing of e-cigarettes

disposable e-cigarettes, 155, 155f

Internet coupons and discounts, 163

policies, 7, 204–205, 238

sales, impact on, 155–157, 155f, 156f

Primacy, defined, A2.2-4

Print media/magazines, and advertising, 158–159, 158f, 160–162f

Processed tobacco, defined, 200t
E-Cigarette Use Among Youth and Young Adults

Index 271

Pro-Children Act of (2001), 192t

Product placements, e-cigarettes, 15

Promotion or promotional activities. See Marketing

Propanol, aerosolized toxicant, 118

Propylene glycol (PG)

aerosol inhalation, 115

inhalation toxicity, 114

secondhand exposure, and California level standards, 123

Pruning of unnecessary synapses, and nicotine exposure, 104–105

Psychiatric events, and rimonabant, 117

Public and Indian Housing (PIH), 197t

Public health

agencies role in assisting state attorney general or FTC, 206

e-cigarettes policy, 7

e-cigarette use, 10–11

FDA regulatory authority, 16

future regulatory options, 17–18

precautionary strategies to protect youth and young adults, 226

Public Health England (UK), 222t

Public policy

cigarette restrictions, 149

e-cigarettes, 7, 187–188, 205

magazine advertisement, 161f, 162f

retail sales of e-cigarettes, 168

“Puff topography,” dose and effects of inhaled nicotine, 100–101

Puff volumes, dose and effects of inhaled nicotine, 101

Purchase channels for e-cigarettes, 149–151

R

Race/ethnicity

e-cigarette advertising, exposure to, 169

e-cigarette use

current prevalence, 28, 29t, 30t, 31t, 32t

trends in prevalence, 28, 33–37, 34t, 35t

flavored little cigars and cigarillos, 11

flavors in e-cigarettes, 59, 60t

poly-tobacco use

adults (age ≥25), 55t

young adults, 53, 54t

youth, 37, 41t

retail sales of e-cigarettes, 150, 168

Regulation of e-cigarettes. See also specific agencies by name

federal

approach to, 15–18

policies of federal agencies, 189–202t

Tobacco Control Act, 187–188

state, local, tribal, and territorial governments

clean air policies, 188

control measures, 184

interventions policies, 188

Tobacco Control Act, 16

Research

suggestions for future research, 185–186, 226, 247–248

tobacco control and prevention, 238

tobacco industry-supported, 195t

Respiratory irritation, acrolein, 117

Retail environment

e-cigarette sales, 14

U.S. market, 150t, 152–154, 153f, 154f, 167–169

Revel smokeless tobacco product, 9

Reward-seeking behavior

adolescent smoking and long-term changes in reward system, 106

nicotine, increased sensitivity to, in adolescents, 105

Reynolds American Inc. (RAI) (R.J. Reynolds Vapor Company)

American manufacturing, 152

company profile, A4.1-3t

multinational tobacco company, 15t

Premier “smokeless cigarette product,” 9

VUSE, 150, 152, 158

Rimonabant (Zimulti), aerosolized adulterant, 117

Risk assessments, 186t

Risk perceptions, knowledge and attitudes, 171

Risk tradeoffs, 184–185

Risky behaviors, and e-cigarette use, 57–58

R.J. Reynolds. See Reynolds American Inc. (RAI)

Rolling Stone magazine, 159, 161f

Ruyan e-cigarettes

introduction of, 10

manufacturer, 15t

S

Safe and Drug-Free Schools and Communities Act (1994), 192t

Safety

battery explosions and fires, 14, 119

burden of proof, responsibility for, 238, 242

cigarette marketing, 8

e-cigarette products and components, 13–14

SAMHSA (Substance Abuse and Mental Health Services 

Administration), 196t

Satisficing, defined, A2.2-4

Schools, proximity to, and e-cigarette availability, 168

Secondhand exposure 

aerosolized e-cigarette constituents, 120–123, 123f, 183, 209t, 240

e-cigarettes, 14

nicotine from e-cigarettes, compared to conventional 

cigarettes, 97

nonusers of nicotine, exposure to, 120

teratogenic effects, 108

Seizures, 117

Sensory deficits, with maternal smoking, 109–110

SFATA (Smoke Free Alternatives Trade Association), A4.2-2, 

A4.3-2

SIDS. See Sudden infant death syndrome (SIDS)

Silicates, aerosolized, 119

Silver, aerosolized, 119

Smoke Free Alternatives Trade Association (SFATA), A4.2-2, A4.3-2

Smokefree policies, 188, 243–244

Smoker Friendly International, LLC, A4.1-10t

Smoker’s One Choice e-cigarettes

market share, (2011), A4.5-3f

sales (2010-2014), 153f, A4.4-2 to A4.4-6t
A Report of the Surgeon General

272 Index

Smoking and Health: Report of the Advisory Committee to the 

Surgeon General of the Public Health Service (1964 report)

mortality contribution results, 8

release of, 4

Smoking behavior

changes, with low-nicotine cigarettes, 9

dose and effects of inhaled nicotine, 100–101

Smoking cessation

in clinical care setting, 206

e-cigarettes as cessation option, 183, 184, 186, 206

magazine advertisement, 161f

reason for trying e-cigarettes, 75

screening and cessation services, 193–194t

studies showing inconsistent results, 214t

Smuggled Tobacco Prevention (STOP) Act (proposed), 198t

SNAP program, 190t

Snus

cardiovascular risk, 101

modified tobacco product, 9

Soap Opera Digest, 161f

Social media. See also Facebook; Twitter; YouTube

advertising, 157

distribution and purchase channels, 150

e-cigarette marketing, 10, 15

e-cigarette promotion, 166–167

Social Security Act (2010 amendments to), 193t

Socioeconomic status, and price of e-cigarettes, 157

Solvents, and aerosol inhalation, 115

Sottera, Inc. See NJOY

Sottera, Inc. v. U.S. Food and Drug Administration (2010), 16, 

241, A4.2-2

Spin magazine, 162f

Sponsorship of events by e-cigarette companies, 15, 159, 163, 240

Sports Illustrated magazine, 160f

Stanford Research into the Impact of Tobacco Advertising 

research group, 158

Starfire e-cigarettes, television advertising, 159

State, local, tribal, and territorial governments

best practices of, 245

e-cigarette taxation policies, 204

ENDS regulations, 209t

existing rules that constrain marketing, 205

licensing, 203

population-level strategies, 243

Tobacco Control Act, 188

tobacco control strategies, 16, 18, 226, 238, 242

Stimulus-response-discrimination-learning processes, 107

Studies. See Surveys

Styles (HealthStyles, Summer Styles) Survey

e-cigarette use data

items from sources of national data, A2.2-5 to A2.2-9t

sources of national data, A2.1-4 to A2.1-5t

prevalence of e-cigarette use, 37, 40f

profile of, A2.1-3

Styrene, aerosolized, 118

Substance Abuse Prevention and Treatment Block Grant, 196t, 203

Substance use and abuse

adolescent smoking as “gateway” for, 106

comorbid, with adolescent smoking, 106

e-cigarette use with, 57–58

fetal effects from nicotine exposure, 111–112

Sudden infant death syndrome (SIDS)

e-cigarettes, 7

fetal effects of nicotine exposure, A3.1-33t

fetal exposure to nicotine, 7

maternal smoking, 109

Surgeon General Call to Action

curb advertising and marketing, 246–247

do no harm, 237–239

expand surveillance, research and evaluations, 247–248

prevention programs and policies, 243–245

provide information about dangers, 239–241

regulate e-cigarettes at federal level, 241–243

stakeholders, 237

Surgeon General’s reports, health risks outlined in previous 

reports, 97–99, 98–99t. See also individual reports by name

Surveillance

proposals, 205, 226, 247–248

studies, 27

Surveys. See also specific survey or study by name

data analysis instruments, A2.2-4

e-cigarette and other tobacco product use, A2.3-4

future research, 185–186

measurement factors, special issues, A2.2-4

modeling concepts, 186

prevalence estimates, 204, A2.3-2 to A2.3-3

Susceptibility to use

advertising and, 170

current prevalence of high school students, 28, 30t

current prevalence of middle school students, 28, 29t

defined, A2.2-3

intentions to use, A2.3-20t

survey summary data, A2.3-20 to A2.3-22t

Synar Amendment, 196t, 203

T

Tank devices (“mods”)

appearance of, 3f, 11

components of, 12f

increasing role in e-cigarette market, 150

plasma nicotine concentration, 103f

product evolution, 151, 152

Tar reduction, health effects of, 8–9

Taxation

e-cigarette policies, 188, 204–205, 238

ENDS, 209t, 210t

Tobacco Tax and Trade Bureau, 200t

Television advertising, 157, 158f, 159

Temperature of e-cigarettes

aerosolized carbonyls, 117, 118

higher, and increased nicotine and toxicant release, 13

toxicants, 118

Tetrahydrocannabinol (THC)

aerosol inhalation, 58

tank devices, 14

Theory of Reasoned Action, tobacco use, and perception of harm, 64
E-Cigarette Use Among Youth and Young Adults

Index 273

Thermal metered-dose cannabis inhalers for medical applications, 58

Third-hand smoke

described, 120, 121

exposure, 209t

Tiered tax rate systems, 204

Tin, aerosolized, 119

Tobacco Control Act (2009)

deeming rule, 17

e-cigarette regulation relating to youth and young adults, 18

federal authority to regulate tobacco products, 9, 15, 16, 183, 

187–188, 241

flavor ban for cigarettes, 11

flavors in cigarettes, 58

state, local, tribal, and territorial government authority, 16

vape shops, mixing e-liquids, 169

youth tobacco access control regulations, 203

Tobacco Control Legal Consortium, 204, 225

Tobacco Free North Dakota, 225

Tobacco-free policies, 240

Tobacco industry companies, A4.1-2 to A4.1-3t

Tobacco industry-supported research and funding, 195t

Tobacco Laboratory Network, 200t

Tobacco Product Directive (TPD), 222t

Tobacco products. See also Aerosol inhalation; Aerosolized 

nicotine; Cigarettes; E-cigarettes

combustible, 6

e-cigarettes regulated as, legal basis for, 16–17

FDA regulation of, 9–10, 15–17

smokeless, 9

sponsorship of events, 15, 159, 163, 240

Tobacco Products and Risk Perceptions Survey (2014), A2.3-3

Tobacco Products Directive, European Commission, 213t

Tobacco-specific nitrosamines (TSNAs), 99, 116

Toluene, aerosolized, 118–119

Toxicants

aerosolization process, 114, 118–119

aerosolized adulterants, 100, 116–117

fetal development, 108, 109

flavorants, 116

prenatal exposure, 108, 109

TPD (Tobacco Product Directive), 222t

Trade organizations and partnerships, e-cigarettes, A4.3-2

Trigeminocardiac reflex, SIDS and maternal smoking, 109

Trinkets & Trash archive, 158

TruNic, A4.1-12t

Truth Initiative (American Legacy Foundation), 158, 159, 163

TSNAs (tobacco-specific nitrosamines), 99, 116

21st Century Smoke e-cigarettes

market share, (2010–2014), A4.5-2 to A4.5-5f

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

website access restrictions, 166t

Twitter

advertising, 157

coupons and discounts, 163

distribution and purchase channels, 150

e-cigarette promotion, 166, 167

e-cigarettes, 15

2-methoxycinnamaldehyde, cytotoxicity of, 116

2,3-butanedione (diacetyl), aerosolized flavorant, 116

U

Uniform tax rate systems, 204

United Nations Educational, Scientific and Cultural Organization 

(2005), 183

USA Liquid Nicotine/USA Laboratories, A4.1-12t

U.S. Coast Guard, 196t

U.S. Department of Agriculture (USDA), 190t

U.S. Department of Defense (DoD), 188, 191t

U.S. Department of Education, 192t

U.S. Department of Health and Human Services (USDHHS)

National Advisory Council on Drug Abuse, 195t

National Institute on Drug Abuse, 195t

National Institutes of Health, 195t

preparation of Surgeon General’s report (2016), 4–5

Substance Abuse and Mental Health Services Administration, 196t

tobacco screening and cessation, 193–194t

U.S. Department of Homeland Security (DHS)

Bureau of Immigration and Customs Enforcement, 196t

Coast Guard, 196t

U.S. Department of Housing and Urban Development (HUD), 197t

U.S. Department of Justice

Bureau of Alcohol, Tobacco, Firearms and Explosives, 198t

Bureau of Prisons, 198t

U.S. Department of Labor, 199t

U.S. Department of Transportation (DOT)

e-cigarette regulations, 188

Pipeline and Hazardous Materials Safety Administration, 199t

tobacco use on aircraft, 199t

U.S. Department of Treasury, 200t

U.S. Department of Veterans Affairs, 188, 201t

U.S. Environmental Protection Agency (EPA)

e-cigarette regulations, 188, 201t

formaldehyde as carcinogenic, 117

U.S. Federal Trade Commission (FTC)

agency profile and policies, 189t

description and authority of, 201t

monitoring advertising, 246

public health agency interaction, 206

source disclosure of advertorials, 205–206

tar and nicotine content in advertising, 9

U.S. Fire Administration, 119

U.S. Food and Drug Administration (FDA)

areas not authorized to regulate, 242

authority to regulate tobacco products, 9, 238

Center for Devices and Radiological Health (CDRH), 16

Center for Drug Evaluation and Research (CDER), 16

Center for Tobacco Products (CTP), 17, A2.1-3

deeming rule, 6, 17

e-cigarette regulation as tobacco products, 16–17

e-cigarette rules, 241–242

e-cigarette shipments, denying entry to, 16

future regulatory options, 17–18

litigation against, 187, A4.2-2

minimum age requirements in retail environments, 167

nicotine regulation, 9–10, 183, 187–188
A Report of the Surgeon General

274 Index

PATH study. See Population Assessment of Tobacco and 

Health (PATH) study

product warnings, 206, 211t, 213t, 216t, 240–241

Sottera, Inc. v. U.S. Food and Drug Administration, 16, 241, 

A4.2-2

tobacco product regulation, 9–10, 15–16

U.S. Pharmacopeia (USP), 114

U.S. Preventive Services Task Force, 206

U.S. Supreme Court, 9

U.S. Trade Representative (USTR), 189t

Us Weekly magazine, 159

V

V2cigs

plasma nicotine concentration, 103f

sales (2010–2014), 153f, A4.4-2 to A4.4-6t

Vape Holdings, Inc., A4.1-6t

Vape pens

components of, 12f

term usage, 3

Vape shops

clean indoor air, legislation, 225

e-cigarette sales, 14, 203

e-liquid mixing, 120

market for e-cigarettes in the U.S., 149, 150–151, 150t, 168–169

Vape tanks, components of, 12f. See also Tank devices (“mods”)

Vegetable glycerin (VG)

aerosol inhalation, 115

nose-only exposure to, 114

Vending machine sales, regulation, 203, 242

Visual processing, deficits in, with maternal smoking, 110

Volatile organic compounds (VOCs), 118–119

VUSE e-cigarettes

distribution and purchase channels, 150

manufacturer, 15t

market share (2014), A4.5-5f

promotion of, 152, 153f, 158

website information, 165, 166, 166t

W

Warning labels

on e-cigarettes, 206, 211t, 213t

on refill bottles, 216t

on tobacco products, 240–241

Whites. See Race/ethnicity

WIC program, 190t

Withdrawal symptoms (physical abstinence syndrome)

conventional cigarettes, 102

e-cigarettes, A3.1-3 to A3.1-6t

Workplace exposure, e-cigarette aerosol, 123

World Health Organization (WHO)

indoor air quality, 122

position on ENDS, 219–220t

Tobacco Laboratory Network, 200t

X

Xylenes, aerosolized, 118–119

Y

Young adolescents, ages of, 4

Young adults. See also Surgeon General Call to Action

ages of, 4

awareness of consequences of e-cigarettes, 240

current prevalence of e-cigarette use, 37, 38t

e-cigarette use

intentions to use summary data, A2.3-20 to A2.3-22t

items from PATH, A2.2-10 to A2.2-15t

items from sources of national data, A2.2-5 to A2.2-19t

patterns of use summary data, A2.3-5, A2.3-23 to A2.3-37t

survey data sources, A2.1-4 to A2.1-5t

surveys, A2.1-3

susceptibility summary data, A2.3-20 to A2.3-22t

flavors in e-cigarettes, 59, 60t

perceived harm of e-cigarettes, 64, 74t, 75

poly-tobacco use, 53, 53f, 54t

prevalence of e-cigarette use, 204, A2.3-3

Surgeon General’s reports focusing on, 4

trends in prevalence of e-cigarette use, 37, 40f

Youth. See also High school students; Surgeon General Call to 

Action

access prevention policies, 203

advertising and marketing restrictions, 208t

ages of, 4

attention and cognition with nicotine exposure, 106

awareness of consequences of e-cigarettes, 240

current e-cigarette use, increase of, 10

current prevalence of e-cigarette use

ever use, 28, 29t, 30t

frequency of use, 28, 29t, 30t

past-30-day use, 28, 31t, 32t

susceptibility to use, 28, 29t, 30t

e-cigarettes, as most commonly used tobacco product, 5

e-cigarette use

higher than other tobacco products, 211t

intentions to use summary data, A2.3-20 to A2.3-22t

items from PATH, A2.2-10 to A2.2-15t

items from sources of national data, A2.2-5 to A2.2-9t

nicotine exposure effects, human studies, A3.1-8 to A3.1-17t

nicotine exposure effects, preclinical/animal studies, 

A3.1-18 to A3.1-32t

patterns of use summary data, A2.3-4, A2.3-6 to A2.3-19t

survey data sources, A2.1-4 to A2.1-5t

survey descriptions, A2.1-2

susceptibility summary data, A2.3-20 to A2.3-22t

flavored little cigars and cigarillos, 11

flavors in e-cigarettes, 59, 60t

legislation to curb tobacco sales, 224

mood disorders with nicotine exposure, 107

nicotine, effects of, 104–107

perceived harm of e-cigarettes, 64, 73t, 74t
E-Cigarette Use Among Youth and Young Adults

Index 275

poly-tobacco use, cross-sectional studies of

current prevalence, 37, 40f, 41–42t, 43, 44t, 45t, 46f

trends in prevalence, 43, 47–48t, 49–50t, 51f, 52f, 53

prevalence of e-cigarette use, 204–205, A2.3-2 to A2.3-3

restricting access to e-cigarettes, 244–245

reward-seeking behaviors, 106

Surgeon General’s reports focusing on, 4

tobacco cessation services, 193t

trends in prevalence of e-cigarette use

ever use, 28, 33, 33f, 34t, 35t

past-30-day use, 31t, 32t, 36–37, 36f

Youth Risk Behavior Surveillance System (YRBSS)

overview and methods, A2.1-4 to A2.1-5

data for report, source for, 27

e-cigarette use

current prevalence, 28

patterns of use, 2015 survey, A2.3-2

sources of national data, A2.1-4 to A2.1-5t

YouTube

distribution and purchase channels, 150, 151

e-cigarette promotion, 166–167

e-cigarettes, 15